Provider Demographics
NPI:1124468343
Name:LAWSON, RENEE R (RN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:R
Last Name:LAWSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:R
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1020 PIEDMONT CT
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3947
Mailing Address - Country:US
Mailing Address - Phone:307-851-7969
Mailing Address - Fax:
Practice Address - Street 1:1020 PIEDMONT CIRCLE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4619
Practice Address - Country:US
Practice Address - Phone:307-851-7969
Practice Address - Fax:307-856-2600
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY32188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY105726000Medicaid